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_ _�_.. --- - _ • - _, .- _ - _ --_._.-_----...... -- --.... . ---- . � ������ - J CITY OFDIAMOND BAR �� COMMiJNITY DEVELOPMENT DEPARTMEfYT /� � . �,.0 � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ~''"'� BUILDING PERMIT APPLICATION FIRM LY oy JOBS�TE v� / APPUCATION PERMIT p/C ADDRESS DATE �� NUMBER � M g ISSUE TYPE OCC -- APN LOT TRACT DATE CONST. GROUP p OWNER "' ADDRESS ZONING SETBACKS $ CITY IP EL. FRONT RW ❑ g APPLICANT TEL REAR ❑ � SIDEISIDESTREET RW p � CONTflACTOR SIDE p o ADDRESS PROPOSED USE CITY ZIP TEL. � o ARCFVENG/ �z,, DESIGNER NO.DWEL NO. NO. 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Z TION.THE OMRJERbUILDEN WiLL HAVE TNE BUROEN OF PNOVWO THAT HE OR SHE OD NOi BUI(�OR � W PROVE FOR TME PURPOSE OF SALE} w 04ASOWNEROFTHEPIqPERTY,AME%CLUSNEIYCONiMCTNOWRMUGENSEDCON�NACTORS � TO CONSTRUCT THE VNWECT(SEG 7a4 BUSINE55 AND GROFESSION4 CODE:7ME N1/fRACTOR4 LI. VelU9�l011 ADJ.AREA W CENSEUWDOESNOTAGPLYTOANOY.TIEROFAPROPERTYN'Fq8UM1D50RWPROVE7iHEREON,AND F NM1IOCONTMCfSiOqSUCHPR0.1ECf5'M7HACONiMCTDR(SIUCENSEDPURSUANT70TMECONTMG pUANTITY DESCRIPTICN �E . � TORS UCENSE IJ�W} � O I IJI EXE�PT UNDER SEC. B.t V.G fOil iNIS RFASOl1 � ✓ LL' DATE OWNEH Z � �� Q� UCENSED CONTRACTORS OECLARATION 2 INEREBYAFFIRYUNDERVENALTYOFVE0.NRYTIUTI.WUCENSEDUNDENPROVISIONSOFCHAPiER V, I 4 d �(COMUENCWONA7HSECTION7aoo�OF01N5qN]OFTMEBUSINESSANDPROFESS�ONSCODE,MD Z. ' X YY LICENSE IS N FIAI fORCEAND EFFEGi. L1J � � LICENSE CU155 IC.NO.� � V DATE CONTRACTOR � � W � WORKERS'COMPENSATIONOECL.AFlATION �f`C� - � IMEREBYAFFIRAIUWERVENALTYOfPEM1F1Y0NEOFTHEiOLI�NaDECURAT10N5: N � _111�YEANOYNLLEWNTNNACERTIFIGITEOFOONSEHTTOSELfaHSUHEFORWOqKERS' � CqAPEN5A7qN,ASPRONDEDBVSECT10N77000FTHEUBORCODf,FORTNEPERFORMNICE OFTHE WORK FOii WH1R1 THIS PENMIT 15155UED. w 0 � � _IH�YEANOVALLMNMAPlWORKERS'COYPENSATqNINSURANCE,ASRE0U1RED8YSECTqN � 770aOFTHELABORCODE.FORTI7EPERfORMANCEOFTHEYVO/iNFOHWFnp1THI3PER1AR15 = ISSUED.MYYY0�7KE 5'COM ENSATpI NMICEC/AN�/qiERANDPOIICYM11A9ERME: CONSTAUCTION � GRRIER � ^ `^ PLAN PEVIEW Z POLICYMIYBER � �.1� � EF'��L� Q o mtssErr�rcmNoreEm.s��cnoF,}ev�aurs�or+acKra�woouusa+omon�ssy uMei i_ Z ICERTIfYTHAiNTHEOERFOii�.1MaGEOFTNEWORKFORWHICHTHISPfiWiTI5155UED,1 MECHANICAL U' SFULLNOTEMPLOYANYPER50NWANYYnNNERSOASTOBECOME3UBJECTTO7HE y WORKERS'COMPENSATIOHIAwSDFC�IIFORNIA,ANOAGHEETHATIF15110UlDeECOME INSPECTIONFEE "< < �' - '��'. S SUBJECTTOTHEWOHKERS'C0IAPENSATIONPHOVISqNSOF6ECTiON77000FT11ELA80R E <�il:L� t,+ _ caoe.�s�uuca+rHvnn+cour�rwirNnasEraonsar+s. ISSUANCE tl ia c..a• O p DATE: APPLIGWT. SMIP � ENERGY P/C WAAMNO:fAtUPE TO SECUNE WOFiKERS'Cp.1PEN5AT10N COYEMGE IS UNUWFUL.ANO SNM16E � SUB.IECTANF►1PLOYFRTOCWMINALPENALTESANDpVILiWESUPMONENUN7REDTN0U5AND ENERGYPERMIT DOLU�RS(S1oo.o001.N/OOITION TO THE GOSi OF ODMPENSATqN,OAMAGES AS PROVIOED FOii 1N � BECTION�7wOFT1ELABORCOOE,NTEPE3f,AND1ITTORNEY5FEE3. RETENTIONFEE: � oCONSTRUCTION IENDING AGENCY PRE-ALT FEE: 0. INERfBYAFF�RMUNOEROFN.LLTYOFVEPJURYTIIATTHEREISACONSTRUCTIONLFN01rMAGENCY � � � LON ME OERiOaAANCE OF TME WOHK FOR WH�CH THIS VERMIT IS ISSUED(SEG 7oV7,pY.4�. � � LENDER'3 NAME � . � LENDER'S AGORESS W �GEHT�FYTHATINAVEREADTItlSAViLICAiIDN/WDSTATETHATT/1EABOVENfOiWATqNISCORFECL TOTAL FEES . d 1110REETOCOMPlYN77NALLC1iYANOCOUNTYORDWMICE5ANO5TATEUWSAEUTINOTOBUIl01NG �'���� � CONS7NUCTION,µD MEFEBYnUT1qRi2E AEPRESEMA7NE5OF TH4 COIMTY TO ENTEH UPON TME ABOV�1ENTqNEO iROVERTY iPR W SPEGT�ON YURPOSES. p � 3` � COMMEMiS a ', �� �� b o p° oE rr �Ivnvfr� 4 N � SI EO PENM E DA7 2 RECPT.N0. PAID BY WWOATIO F WH17E—DepartmentCopy.YELLOW—Fnsnce PINK�Assssaor Copy, Copy,GOLDENROD�ile Ccpy.GREEN—Applbant's Copy . � ' ., :. ...y.,• . .. .. . .. . � . . . � . �� ... . . �-�—�i!.; , , .. ;� .... .. ... . . . ,... • '. � ' � ' � �� ' ��' � � - . �t�' .. .. . . . . i . 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